Comprehensive study of allergic deaths in US finds medications are main culprit

September 30, 2014--(BRONX, NY)--Medications are the leading cause of allergy-related sudden deaths in the U.S., according to an analysis of death certificates from 1999 to 2010, conducted by researchers at Montefiore Medical Center and Albert Einstein College of Medicine of Yeshiva University. The study, published online today in the Journal of Allergy and Clinical Immunology, also found that the risk of fatal drug-induced allergic reactions was particularly high among older people and African-Americans and that such deaths increased significantly in the U.S. in recent years.

Anaphylaxis is the term used for a severe, potentially life-threatening allergic reaction that can occur within seconds or minutes following exposure to an allergen. Until now, data on trends in anaphylactic deaths--or even the number of yearly deaths from anaphylactic shock--has not been well-defined. One reason: unlike countries such as the UK, the U.S. doesn't maintain a national registry for anaphylaxis deaths.

"Anaphylaxis-related deaths in the U.S. have not been well understood in recent years," said Elina Jerschow , M.D., M.Sc. director, Drug Allergy Center, Allergy and Immunology Division of Medicine, Montefiore Medical Center, and assistant professor of medicine, Albert Einstein College, the lead author of the study. "We hope these findings will help in identifying specific risk factors and allow physicians to formulate preventative approaches."

Dr. Jerschow and colleagues analyzed death certificates from the U.S. National Mortality Database and found that medication-related anaphylaxis was the most common cause of death (58.8 percent). Additional causes identified included unspecified anaphylaxis (19.3 percent), venom (15.2 percent) and food (6.7 percent). Further analyses revealed fatal anaphylaxis due to medications, food and unspecified allergens was significantly associated with African American race and older age; and fatal anaphylaxis rates due to venom was more common in white, older men.

Of the 2,458 deaths identified between 1999-2010, 1,446 were from medications. The culprit drugs were not specified in most of the cases (approximately 74 percent). However, among those with an identified culprit drug, nearly half were antibiotics, followed by radiocontrast agents used during diagnostic imaging procedures and chemotherapeutics that are used in treatment of cancer.

During the years studied, there was a significant increase in fatal drug anaphylaxis, from 0.27 per million in 1999-2001 to 0.51 per million in 2008-2010. The increase in medication-related anaphylaxis deaths likely relates to increased medication and radiocontrast use, enhanced diagnosis and coding changes.

"Anaphylaxis has been dubbed 'the latest allergy epidemic,'" said Dr. Jerschow. "The U.S. and Australia have some of the highest rates of severe anaphylaxis among developed countries. We hope these results bring increased awareness of the need for a better understanding of anaphylaxis deaths."

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In addition to Dr. Jerschow, authors include Moira M. Scaperotti B.S., and Aileen P. McGinn, Ph.D., both at Einstein, and Robert Lin, M.D., M.Sc., at Weill Cornell Medical College. This research was supported in part by the Clinical and Translational Science Award from the National Institutes of Health to Albert Einstein College of Medicine (UL1 TR001073). The researchers report no conflicts of interest.

About Montefiore Medical Center

As the University Hospital for Albert Einstein College of Medicine, Montefiore is a premier academic medical center nationally renowned for its clinical excellence, scientific discovery and commitment to its community. Recognized among the top hospitals nationally and regionally by U.S. News & World Report, Montefiore provides compassionate, patient- and family-centered care and educates the healthcare professionals of tomorrow. The Children's Hospital at Montefiore is consistently named in U.S. News' "America's Best Children's Hospitals." With four hospitals, 1,491 beds and 90,000 annual admissions, Montefiore is an integrated health system seamlessly linked by advanced technology. State-of-the-art primary and specialty care is provided through a network of more than 130 locations across the region, including the largest school health program in the nation and a home health program. Montefiore's partnership with Einstein advances clinical and translational research to accelerate the pace at which new discoveries become the treatments and therapies that benefit patients. The medical center derives its inspiration for excellence from its patients and community, and continues to be on the frontlines of developing innovative approaches to care. For more information please visit http://www.montefiore.org and http://www.montekids.org. Follow us on Twitter; like us on Facebook; view us on YouTube.

About Albert Einstein College of Medicine of Yeshiva University

Albert Einstein College of Medicine of Yeshiva University is one of the nation's premier centers for research, medical education and clinical investigation. During the 2013-2014 academic year, Einstein is home to 743 M.D. students, 275 Ph.D. students, 103 students in the combined M.D./Ph.D. program, and 313 postdoctoral research fellows. The College of Medicine has more than 2,000 full-time faculty members located on the main campus and at its clinical affiliates. In 2013, Einstein received more than $150 million in awards from the National Institutes of Health (NIH). This includes the funding of major research centers at Einstein in aging, intellectual development disorders, diabetes, cancer, clinical and translational research, liver disease, and AIDS. Other areas where the College of Medicine is concentrating its efforts include developmental brain research, neuroscience, cardiac disease, and initiatives to reduce and eliminate ethnic and racial health disparities. Its partnership with Montefiore Medical Center, the University Hospital and academic medical center for Einstein, advances clinical and translational research to accelerate the pace at which new discoveries become the treatments and therapies that benefit patients. Through its extensive affiliation network involving Montefiore, Jacobi Medical Center -- Einstein's founding hospital, and three other hospital systems in the Bronx, Brooklyn and on Long Island, Einstein runs one of the largest residency and fellowship training programs in the medical and dental professions in the United States. For more information, please visit www.einstein.yu.edu, read our blog, follow us on Twitter, like us on Facebook, and view us on YouTube.

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